Minimising Unnecessary Starving Fasting Pre Surgery Minimising Unnecessary Starving 21 May 2014 Andrew Jones Quality Improvement Specialist Waitemata District Health Board

Background Patients reported to fast for extended periods of time Unclear processes for changes to procedure schedule Results in deconditioning and malnutrition

Scope of Project Preoperative Fasting Essentials of Care ERAS & #NOF Pathway Preoperative Fasting Essentials of Care Nutrition & Hydration

Policies For surgical patients: 6 hours fasting 2 hours nil by mouth or midnight/7am for electives Also range of time frames for wide range of procedures

Initial Scoping 6 & 2 Time frames confirmed by Anaesthesia Clinical Director Awaiting responses from other CDs Snap shot of current practice on wards

Stocktake Three wards Audit on 52 patients over three weeks

Fasting Time

Fasting Time N = 14 Average NBM HRS 11.6 N = 31 Average NBM HRS 14.3

Fasting Time 10% of surgeries were postponed One patient: Surgery postponed 3 times 16 hours of fasting time each time The average NBM time for postponed patients: 13 hours

Next Steps Prospective review of NBM cases Identify flexibility of Trendcare for recording: Actual time last food Actual time last oral fluids Agreement on fasting/NBM times for all procedures

Next Steps Target one clinical environment Test innovative process changes!

Thank You Any Questions?